Louise Lambert-Lagacé, C.M.,
C.Q., dt.p.

Childhood obesity is a growing problem in many countries of the world
and strategies to prevent this serious problem are greatly needed. Three
years ago, the World Health Organization looked at the prevalence of
overweight in preschool children around the world including developing
countries; one hundred sixty nationally representative cross sectional
surveys from 94 countries were analysed ; overweight was defined as a
weight for height that exceeded more than 2 standard deviations from the
WHO international median. The global prevalence of overweight before the
age of 6 was 3.3% . US figures were 4.5 % in 1988-1994 while Canada's
figure dated back to 1970 ( Nutrition Canada survey) showed a prevalence
of 5.4% way back then..

A more very recent overview of childhood obesity and underweight trends
is presented in the June issue of the Journal of Clinical Nutrition and
was prepared by the Carolina Population Center in Chapel Hill.

For children between 6 and 18 years old

Brazil

1975

1997

overweight

4.1 %

13.9 %

underweight

14.8

8.6

China

1991

1997

overweight

6.4 %

7.7 %

underweight

14.5

13.1

USA

1971-1974

1988-1994

overweight

15.4 %

25.6 %

underweight

6.1

3.3

Russia

1992

1998

overweight

15.6 %

9.0 %

underweight

6.9

8.1

Canada

1981

1996

overweight

15. %

23.0 % among girls

28.8 % among boys

obese

5. %

11.8 % among girls

13.5 % among boys

Studies are also telling us not only that children are heavier but that
heavy children are heavier. Ten or fifteen years ago, children going for
treatment were 40% overweight, now they are often 80% overweight reveal
some clinicians from Stanford University. Parents worry when their toddler
refuses to eat, but then , they need to worry when children start to
thicken …

Why are children getting heavier?

too much television

children watching 4 hours daily are 2.5 times more likely to be or
become obese

children from families with high television use are eating more
pizzas, salty snacks, and sodas and less fruit and vegetable

ever growing portion sizes in recipes and in restaurants

too little physical activity in the schools

the changing eating environment in which children learn to eat

the changing home eating patterns

foods prepared outside the home

different members of the family taking charge

frequent use of convenience foods and single serve items

numerous and contradictory messages

parents who can't say no

In a letter addressed to President Clinton in 1993, the American
Dietetic Association wrote: " Over the past 20 years, children have become
neglected. More families have become too removed to be aware of or to
fulfil their children's needs. More children have become distressed by
isolation, marital disruption, substance abuse, physical or sexual abuse,
parental loss, or physical jeopardy. To blunt their difficult feelings,
children develop excessive appetites for food or inactive pursuits, such
as video games and television. Indulgence, another form of neglect, has
also become more common. " The letter continued with a vibrant plea for
governmental action . ADA had a long list of suggestions and I guess the
list was heard.

Major Studies are going on in US at the moment:

Healthy Lifestyles Research Study with CDC, dieticians and
paediatricians , aims at creating family behaviours that support healthy
life styles and ultimately lead to a decreased prevalence of childhood
obesity.

HHS and National Recreation and Park Association; A strategic
partnership to promote community-based health education and activity
programs

CDC and the Institute of Medicine on a study on the nature of
childhood obesity

IRS has a new policy to give tax relief to individuals who pay out
of pocket for weight loss program

CDC state Outreach: Clinton signed on October 17, 2000 the
Children's Health Act authorising CDC to assign grants to states to
establish programs for the prevention of childhood obesity

ADA sponsored program: Childhood Healthy Weight Initiative

The HOPSCHOTH study ( Health Opportunities for Pre school children
to Optimise their Cardiovascular Health) Goal: to change the mother, the
child and the environment.

In Canada,
nothing is being done at the national level.

What about weight reducing diets for young children?Many experts in the field express caution against strict diets for
young children.

The main focus of the treatment should be to keep the weight as stable
as possible so that children can grow into their weight.

Some experts will add that the whole family needs to learn to eat a
healthy diet because it's not the child who is selecting the doughnuts .
Parents make choices and should be role models.

When one consults the recent studies carried by Lean Birch at Penn
State, looking at mothers' child feeding practices. and how those feeding
practices influence young children eating behaviour , one might conclude
that the best predictor for a pre-school child's ability to regulate
energy intake is parental control in the feeding situation.

The more self control the child has, the better able the child will be
to respond to internal controls of hunger and fullness.

The family sets the stage .

The observations and conclusions of a recent Birch study done with
mothers and five year old daughters are thought provoking:

A greater restrictive control is seen when...

eating and appearance are particularly valued or problematic for one
parent.

A mother's efforts to control her own weight as measured by dietary
restraint in combination with her perception of her daughter's risk of
overweight predicted the mother's use of greater restrictive control in
child feeding.

Excessive control in feeding diminishes children's capacity for self
regulation.The transfer of eating and feeding problems between mothers and
daughters may begin during pre-school years.

The overall picture is frightening. Many have agreed in the past that
diets don't work or very rarely work. Now we are seeing that diets may in
fact lead to pervasive ill effects and trigger weight problems for the
next generation. Maternal dieting could lead to childhood obesity

And, now we see that countries that have been dieting for more than one
generation have the highest prevalence of weight problems during childhood.
Obesity has become a major public health issue in our country

There are many avenues to counter act this trend? The one I propose is
toban advertising of all weight reduction diets and weight reduction
products in order to deflate the weight obsession and favor a more
relaxed, pleasurable relation with food during childhood and thereafter…
Before this happens, many questions have yet to be answered

Do we know what thin children are eating? ...what they are doing
differently ?... how , when , and where they are eating ?... what their families are doing
differently?... are mealtime rituals still existent?

We need to measure the quality of foods served instead of counting
calories, and grams of fat We need to take into account the enjoyment and
the pleasure of eating?